IMS 2025 | Frailty-adapted treatment in newly diagnosed multiple myeloma

So when it comes to assessing frailty for patients newly diagnosed with multiple myeloma, frailty impacts treatment selection significantly. And the question is, how do you really define frailty for patients at any point in their myeloma journey? And so the question for clinicians is, is that traditionally this is based upon things like age, comorbidities, and overall underlying health status. But what we’re beginning to learn and understand is that we have much more robust metrics to be able to identify and define frailty for our patient population. There are several tools that have been incorporated for clinical trials, including the IMWG Frailty Index and the Simplified Frailty Index, which are the cornerstone of being able to look at these frailty tools. However, we also recognize that these tools really need to be expanded to be able to fully capture frailty and all the domains of health that are associated with an aging adult with multiple myeloma. So practical approaches to being able to take care of older adults with multiple myeloma, we think about published data that have explored the types of treatment and the dosing of those types of treatment. But in some of those studies, either older adults, those that are in their 80s, were excluded from some of those trials, or alternatively, they don’t necessarily include patients that have underlying comorbidities. And in that case, we think about how we can apply that data to the patient population that’s in our clinic. So some strategies we think about are some dose attenuations and things like lenalidomide, changing the schedule to be more compatible with someone’s underlying health, and how you can take the paradigm or the framework of the clinical trial and then apply it to the patient that you have there in the clinic. So what are other tools that are out there or in development? So as I mentioned, there are some tools that have been used as the cornerstone. And we really need to build upon those and amplify that work. There are many assessment strategies. The fact that people are talking about and using frailty assessments in clinical trials is a strong point. And how can you use those tools within your clinic? So in the larger geriatric oncology community, there is a framework called the practical geriatric assessment in which many of those tools are downloadable, free, and can take the domains of health, looking at things like nutrition, physical function, social support, cognitive function, and taking those aspects of someone’s health to be able to characterize them, and then looking at whether or not there are deficits to be able to identify and improve upon those deficits during a period of time.

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